Bart W. Koes

Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions.

Study Design. A systematic review of randomized controlled trials. Objectives. To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain. Summary of Background Data. Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy. Methods. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. Results. The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100‐point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti‐inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short‐term effects. Conclusions. The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.

Systematic review of psychosocial factors at work and private life as risk factors for back pain

Study Design. A systematic review of observational studies. Objectives. To assess whether psychosocial factors at work and in private life are risk factors for the occurrence of back pain. Summary of Background Data. Several reviews on risk factors for back pain have paid attention to psychosocial factors. However, in none of the published reviews was a strict systematic approach used to identify and summarize the available evidence. Methods. A computerized bibliographical search of several databases was performed, restricted to studies with a cohort or case–control design. A rating system was used to assess the strength of the evidence for various factors, based on the methodologic quality of the studies and the consistency of the findings. Results. Eleven cohort and two case–control studies were included in this review. Strong evidence was found for low social support in the workplace and low job satisfaction as risk factors for back pain. Insufficient evidence was found for an effect of a high work pace, high qualitative demands, low job content, low job control, and psychosocial factors in private life. Conclusions. Evidence was found for an effect of low workplace social support and low job satisfaction. However, the result for workplace social support was sensitive to slight changes in the rating system, and the effect found for low job satisfaction may be a result of insufficient adjustment for psychosocial work characteristics and physical load at work. In addition, the combined evaluation of job content and job control, both aspects of decision latitude, led to strong evidence of a role for low job decision latitude. Thus, based on this review, there is evidence for an effect of work-related psychosocial factors, but the evidence for the role of specific factors has not been established yet.

Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care

Maurits van Tulder (chairman) Epidemiologist (NL) Annette Becker General practitioner (GER) Trudy Bekkering Physiotherapist (NL) Alan Breen Chiropractor (UK) Tim Carter Occupational physician (UK) Maria Teresa Gil del Real Epidemiologist (ESP) Allen Hutchinson Public Health Physician (UK) Bart Koes Epidemiologist (NL) Peter Kryger-Baggesen Chiropractor (DK) Even Laerum General practitioner (NO) Antti Malmivaara Rehabilitation physician (FIN) Alf Nachemson Orthopaedic surgeon (SWE) Wolfgang Niehus Orthopaedic / anesthesiologist (Aus) Etienne Roux Rheumatologist (SUI) Sylvie Rozenberg Rheumatologist (FR)

A Cost-Of-Illness Study of Back Pain in the Netherlands

&NA; In this study we estimated the costs of back pain to society in The Netherlands in 1991 to be 1.7% of the GNP. The results also show that musculoskeletal diseases are the fifth most expensive disease category regarding hospital care, and the most expensive regarding work absenteeism and disablement. One‐third of the hospital care costs and one‐half of the costs of absenteeism and disablement due to musculoskeletal disease were due to back pain. The total direct medical costs of back pain were estimated at US

An updated overview of clinical guidelines for the management of non-specific low back pain in primary care

367.6 million. The total costs of hospital care due to back pain constituted the largest part of the direct medical costs and were estimated at US

Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review

200 million. The mean costs of hospital care for back pain per case were US

Shoulder disorders in general practice: incidence, patient characteristics, and management.

3856 for an inpatient and US

Diagnosis and treatment of low back pain

199 for an outpatient. The total indirect costs of back pain for the entire labour force in The Netherlands in 1991 were estimated at US

Exercise therapy for low back pain : A systematic review within the framework of the Cochrane Collaboration Back Review Group

4.6 billion; US

Prevalence and incidence of shoulder pain in the general population; a systematic review.

3.1 billion was due to absenteeism and US